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doi:10.22028/D291-35740
Titel: | Intravitreal injection with anti-vascular endothelial growth factor (anti-VEGF) in diabetic macular edema (DME) versus vitrectomy with internal limiting membrane (ILM) peeling with anti-VEGF as an adjuvant |
VerfasserIn: | Abdelazim, Mohamed Gaber Okasha |
Sprache: | Englisch |
Erscheinungsjahr: | 2018 |
Erscheinungsort: | Homburg/Saar |
DDC-Sachgruppe: | 610 Medizin, Gesundheit |
Dokumenttyp: | Dissertation |
Abstract: | Summary Background: Diabetic macular edema (DME) is a globally growing health problem and considered the most common form of sight-threatening retinopathy in diabetic patients. Although focal or grid laser photocoagulation was the mainstay of treatment, anti-vascular endothelial growth factor (VEGF) agents are now the standard of care. However, these therapies are expensive and some patients show inadequate response. Purpose: To determine the effect of pars plana vitrectomy (PPV) for DME with preoperative intravitreal bevacizumab (IVB) compared to anti-VEGF only. Methods: This was a retrospective study between 2011 and 2016 of 260 eyes of 130 patients who had vitrectomy for DME (n=130, PPV group, single surgeon AV) and patients who had IVI of anti-VEGF only (n=130, IVI group) were followed for at least 12 month. Charts were reviewed for best corrected visual acuity (BCVA), central macular thickness (CMT) measured by optical coherence tomography (OCT). Results: The mean BCVA in LogMAR improved from 1.08 ± 0.64 at baseline to 0.71 ± 0.55 at 12-month in the PPV group (P < 0.0001) and in the IVI group, from baseline 0.49 ± 0.39 to 0.42 ± 0.36 at 12-month (P < 0.029). The mean CMT improved from 442 ± 200 μm at baseline to 348 ±149 μm at 12-month in the PPV group (P < 0.001). The mean CMT improved from 439 ± 166 μm at baseline to 368 ± 144 μm μm at 12-month in the IVI group (P < 0.001). Preoperative IVB, compared to without IVB, leads to reduction in intraoperative (6 cases vs. 10 cases) and postoperative bleeding (3 cases vs. 13 cases). Conclusion: Vitrectomy with internal limiting membrane peeling is a cost-effective procedure which consistently results in central macular thickness reduction and leads to clinically significant improvement in BCVA comparable to serial intravitreal injection of anti-VEGF. Careful patient selection and meticulous preoperative OCT assessment are critical steps in the decision-making process. Preoperative intravitreal bevacizumab was associated with reduced intraocular bleeding intra- and postoperatively. The complication rate of vitrectomy is low and similar to what has been reported for this procedure. A large, comparative, prospective, randomized clinical trial of these two treatments is needed to determine which therapy is more effective. |
Link zu diesem Datensatz: | urn:nbn:de:bsz:291--ds-357407 hdl:20.500.11880/32588 http://dx.doi.org/10.22028/D291-35740 |
Erstgutachter: | Seitz, Berthold |
Tag der mündlichen Prüfung: | 16-Feb-2021 |
Datum des Eintrags: | 14-Mär-2022 |
Fakultät: | M - Medizinische Fakultät |
Fachrichtung: | M - Augenheilkunde |
Professur: | M - Prof. Dr. Berthold Seitz |
Sammlung: | SciDok - Der Wissenschaftsserver der Universität des Saarlandes |
Dateien zu diesem Datensatz:
Datei | Beschreibung | Größe | Format | |
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Okasha MD final print NO CV.pdf | 905,35 kB | Adobe PDF | Öffnen/Anzeigen |
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